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Obs and Gynae > large for dates > Flashcards

large for dates Flashcards

1
Q

what is large for date?

A

Symphyseal-fundal height >2cm for Gestational age

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2
Q

Causes of large for date?

A

Wrong dates
Fetal Macrosomia
Polydramnios
Diabetes
Multiple Pregnancy
(Obesity)

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3
Q

fetal macrosomia- what?

A

big baby

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4
Q

how is fetal macrosomia diagnosed?

A

USS EFW >90th centile
AC>97TH Centile

AC- abdominal circumference
EFW- estimated fetal weight

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5
Q

Risks related to fetal macrosomia?

A

-clinican + maternal anxiety
-labour dystocia
-shoulder dystocia (more with diabetes)
-PPH (post partum haemorrhage)

shoulder dystocia= babies should trapped behind pubic synphesis

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6
Q

problems with using USS for ESF?

A

-Ultrasound ESF is commonly overestimated
-USS More accurate <38 weeks
-Influenced by BMI of women (harder if higher)
-Operator dependant

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7
Q

Management- fetal macrosomia?

A

-Exclude diabetes
-Reassure

If EFW>/=5kg offer c/section

NICE Recommendation: In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic).

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8
Q

what is polyhamdramnios?

A

Excess amniotic fluid

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9
Q

criteria for diagnosis of POLYHADRIMNIOS?

A
  • Amniotic Fluid Index (AFI >25cm)

Deepest Pool >8cm

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10
Q

maternal risks for polyhadriminios?

A

more likely with diabetes

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11
Q

fetal risks for polyhadriminios?

A

-Anomaly (GI atrsia, cardiac, tumour)
-Monochorionic twin pregnancy
- Hydrops fetalis (Rh isoimmunisation)
-Viral infection (erythrovirus B19, Toxoplasmosis, CMV)
-Idiopathic

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12
Q

presentation for polyhadriminios?

A

Most are asymptomatic

Symptoms
-Abdominal discomfort
-Pre-labour rupture of membranes
-Preterm labour
-Cord prolapse

Signs
-LFD
- Malpresentation
- tense shiny abdomen
-inability to feel fetal parts

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13
Q

investigations for polyhadriminios?

A

DIAGNOSTIC:
Amniotic Fluid Index (AFI) >25cm
Deepest Pool >8cm

USS fetal survey to look at babys:
-lips
-stomach

Exclude risk factors:
OGTT - to exclude maternal diabetes
Serology to exclude viral infection- toxoplasmosis, CMV, Parvovir
Antibody screen

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14
Q

Management for polyhadriminios?

A

-IOL by 40 weeks

Serial USS- growth, LV, presentation

-Neonatal examination

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15
Q

risks in labour for polyhadriminios?

A

Risks during labour:
-malpresentation
-cord prolapse
-Preterm Labour
-PPH

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16
Q

what increases risk of multiple pregnancy?

A

Increased with:
-Assisted conception
-African women
-FH
-increased materanal age
-increased parity
-Tall women> small women

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17
Q

monozygotic- what?

A

splitting of a single fertilised egg

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18
Q

dizygotic- what?

A

fertilisation of 2 ova by spermatozoa

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19
Q

Chorionicity -what?

A

1 or 2 placentas

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20
Q

why is it important to identify monozygotic, dizygotic or chorionicity on USS?

A

important to determine via USS because monochorionic/monozygous twins are at higher risk of pregnancy complication

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21
Q

when would splitting have to occur to have monochorionic twins?

A

Monochorionic will occur if splitting happens after 4-7 days

22
Q

investigations for multiple pregnancy?

A

Multiple pregnancy - confirmed at 12 weeks
-Shape of membrane and thickness of membrane (twin peak at 11-13 + 6 weeks with CRL 45-84mm)
-Fetal sex
-Chorionicity

23
Q

when is the US scan to check for multiple pregnancy?

A

12 weeks

24
Q

symptoms/ signs of multiple pregnancy?

A
  • Symptoms
    • Exaggerated pregnancy symptoms e.g. excessive sickness/ hyperemesis gravidarum
  • Signs
    • High AFP
    • Large for dates uterus
    • Mutiple fetal poles

USS confirmation at 12 weeks

25
Q

complications for fetus in multiple pregnancy?

A

Fetal includes congenital anomalies, IUD, pre-term birth, growth restriction, cerebral palsy, twin to twin transfusion

26
Q

complications for mother in multiple pregnancy?

A

Maternal include hyperemesis gravidarum, anaemia, pre eclapsia

27
Q

complications of monochorionic twins?

A

Single Fetal Death
Selective Growth Restriction (sGR)
Twin-To- Twin Transfusion Syndrome (TTTS)
Twin Anaemia- P0lycythaemia Sequence (TAPS)
Abnormal Dopplers: Absent EDF (AEDF) or Reversed EDF (REDF)

28
Q

at what point does splitting occur for monochorionic twins

A

Monochorionic will occur if splitting happens after 4-7 days

29
Q

what is twin to twin transfusion

A

Syndrome with artery-vein anastomoses. Donor twin perfuses the recipient twin

30
Q

risks of twin to twin transfusion?

A

More common in monochorionic/ monozygotic twins

Rare after 26/40

31
Q

what is seen on USS- twin to twin transfusion?

A

USS:
-Oligohydramnios
-polyhydramnios (Oly-Poly)

32
Q

Management- twin to twin transfusion?

A

Before 26/40 –fetoscopic laser ablation

> 26/40- amnioreduction /septostomy

Deliver 34-36/40

33
Q

complications- twin to twin transfusion?

A

Untreated, TTTS has a high mortality rate for both twins, with the donor more likely to survive
* Mortality >90% with no treatment

Neurological morbidity 37% and high in surviving twin if IUD

34
Q

why do both foetus in twin to twin transfusion risk developing heart failure and hydrops?

A
  • Both foetuses are at risk of developing heart failure and hydrops
  • The donor suffers high output cardiac failure as a consequence of severe anaemia and the recipient suffers fluid overload
35
Q

how are conjoined twins managed?

A

Conjoined twins:
-MDT
-specialised centres

36
Q

maangement- Monochorionic Monoamniotic?

A

-deliver by C/section 32-34 weeks
-higher risk of foetal death due to risk of cord entanglemnt

37
Q

what what point are DCDA twins delivered?

A

37 to 38 weeks

38
Q

what what point are MCDA twins delivered?

A

> 36 weeks with steroids

39
Q

how are triplets delivered

A

cesarean

40
Q

how are MCMA (monochorionic monoamniotic) delivered?

A

ceserean section

41
Q

gestational diabetes- what?

A

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

42
Q

whats different in gestational diabetes compared to regular?

A
  • Increases insulin requirements
  • N&V can precipitate DKA
  • Ketosis more common
  • Diabetic retinopathy worsens especially after rapid control of diabetes

Diabetic Nephropathy can worsen

43
Q

RISKS- gestational diabetes

A

-BMI above 30 kg/m2
-previous macrosomic baby weighing 4.5 kg or above
-previous gestational diabetes
-family history of diabetes (first‑degree relative with diabetes)
-minority ethnic family origin with a high prevalence of diabetes

44
Q

investigation for gestational diabetes?

A

Screening first line= oral glucose tolerance test (OGTT)

Fasting >=5.1 mmol/l

2 hour >=8.5 mmol/l

45
Q

who is screened for gestation diabetes?

A

OGTT is used in patients with risk factors for gestational diabetes, and also when there are features that suggest gestational diabetes:
-Large for dates fetus
-Polyhydramnios
-Glucose on urine dipstick

RISKS:
-BMI above 30 kg/m2
-previous macrosomic baby weighing 4.5 kg or above
-previous gestational diabetes
-family history of diabetes (first‑degree relative with diabetes)
-minority ethnic family origin with a high prevalence of diabetes

46
Q

how often should women with gestational diabetes check blood glucose?

A

measure blood glucose 4x daily:
-fasting (pre breakfast)
-postmeals (1 hour or 2 hours post meal)
-before bed

47
Q

glycaemic targets- gestational diabetes?

A

Fasting 3.5-5.5mmol/l
1hr <7.8mmol/l
2hr <6.4mmol/l

48
Q

At what estimated fetal weight should C section be done for gestational diabetes?

A

> 4.5kg

49
Q

what risk does breast feeding have - diabetes?

A

hypoglycaemia

50
Q

what risk does breast feeding have - diabetes?

A

hypoglycaemia

Obs and Gynae (61 decks)

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